Name:__________________________________________Procedure:______________________________________ProcedureDate:__________________________________ProcedureLocation:_______________________________PatientSignature:_________________________________*Ihavereadandunderstandthesesurgeryguidelines*

PAROTIDSURGERYGUIDELINES

FOURWEEKSPRIOR&FOURWEEKSFOLLOWINGSURGERYo Pre-optestingmustbecompleted.Youwillneedtohavethefollowingtests:Chem7,CBC,

PT,PTT,EKG,Chestx-ray(age45andabove,acceptedupto6monthspriortosurgery)o Nodentalwork(includingdentalcleanings)4weekspriortoand4weeksfollowingsurgery.o Nolaserorchemicalpeeltreatments4weekspriortosurgery,andreceiveclearancefrom

Dr.Larian/Dr.Azizzadehforanylaserorchemicaltreatmentspost-surgery.o Donotdyeyourhairfor4weeksfollowingsurgery.Priortosurgery,youcandyeyourhair.

TWOWEEKSPRIOR&TWOWEEKSFOLLOWINGSURGERY

o Avoidallproductsthatmayinterferewithbloodclotting.Examples:aspirin,ibuprofen,oraspirinbasedproducts,NSAIDS(non-steroidanti-inflammatorydrugs),vitaminEandsupplements,garlicextract,alcohol(includingwineandbeer),herbalproducts,fishoilandfish.

o Avoidallsmokingornicotineproductsincludingnicotinegumandpatch.o Avoidallmedicationsunlessclearedthroughouroffice.Contactprescribingdoctorfor

alternativemedicationifnecessaryandforthemanagementofmedicationsduringyoursurgicalprocedureandrecovery.PleaseNOTIFYUSOFANYMEDICATIONSyouaretaking.Thisincludesoverthecounter,non-prescriptiondrugs.

o Tylenol(acetaminophen)isallowedpre-opandpost-opforpainand/orfever.o Purchase:hydrogenperoxide,Q-tipsandbabyshampoofromalocalpharmacy.o Discontinuealldietpillsorsupplements2weekspriortosurgery.o Avoidadietthatisrichinseafood.

DAY/NIGHTBEFORESURGERY

o Washfaceandshampoohairusingbabyshampooandgentlesoap.o DONOTeatordrinkanythingaftermidnightexceptasdirectedbydoctororstaff.o Youcanhaveclearliquidsupto8hoursbeforesurgery.o Youmaytakeyourusualasthma,heart,bloodpressureorseizuremedicationwithasmall

sipofwaterinthemorning,unlessotherwiseadvised.o Fillandpickupallpost-opprescriptions.o Confirmalltravelcompanionarrangementsareinorderfortransportationtothesurgery

andpickupafter.Thiscompanionshouldremainwithyoufor24hoursfollowingsurgery.YOUWILLNOTBEALLOWEDTOPROCEEDWITHSURGERYUNLESSTHESEARRANGEMENTSAREINORDER.YOUWILLNOTBEALLOWEDTOLEAVETHESURGERYCENTERWITHOUTYOURTRAVELCOMPANION.

DAYOFSURGERY

o Takeanypre-opmedicationasinstructedbydoctororstaff,onlyifpre-approved.o Removecontactlenses.o Removealljewelryandpiercings.o Leavevaluablesathomeorwithfamilymembers.o BringaformofID,insurancecardifnecessary,andmannerinwhichtopayforsurgerycenter,ifapplicable.

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o Wearloosecomfortableclothingandsensibleshoes.Bringwarmsocks,asitmaygetcoldinthesurgerysuite.

o Donotsignanypapers,makeappointmentsorimportantdecisionsfor24hoursaftersurgery.Thepost-opmedicationsmayalteryourjudgment.

AFTERSURGERY

PAROTIDSURGERYBecauseofourminimallyinvasiveapproachtoparotidsurgery,recoveryistypicallyquickandeasy.Infact,almosteverypatienttellsustheycannotbelievehoweasytheoverallrecoveryprocesswasforthem.Youshouldfeelimprovementeverydayaftersurgery.Wehaveputtogethersomepost-parotidectomycareguidelinessoyouknowwhattoexpectfollowingyoursurgery.However,keepinmindthateverypatienthealsdifferently,sothesearemerelygeneralguidelines.DayofSurgery

o Whenyouwakeupfromsurgery,youwillhaveaheaddressingandaplasticdrainagetube.

o Youwillspendafewhoursrecoveringatthesurgerycenter,andwillthenbedischargedtogohomewithyourcompanionortoanaftercarefacility.

o Itisimportantforthefirst24hoursyouhavesomeoneyoucancountontohelptakecareofyou.

o Thedrainshouldbeemptiedatleasttwiceadayandtheamountrecorded.Thisrecordshouldbebroughttoyourfirstpost-opappointment.

POST-OPAPPOINTMENTSPost-OpAppointment#1Yourfirstpost-opappointmentwillbethedayfollowingyoursurgery.AtthisappointmentDr.LarianandDr.Azizzadehwilltakealookatyourincisions,surgicalareaanddraintomakesureeverythingisbeginningtohealproperly.Post-OpAppointment#2Yoursecondpost-opappointmentisgenerally3–4daysfollowingyoursurgery.Atthisappointment,yourdrainwillmostlikelyberemoved.Oncethereislessthan25ccoffluidinthedrainovera24-hourperioditisusuallyreadytocomeout.Removingthedrainisprettypainlessasthetubeisverysmall.Post-OpAppointment#3

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Yourthird,andusuallyfinal,post-opappointmentisgenerally5–8daysfollowingyoursurgery.Atthisappointmentwewillremoveyourstitchesanddoafinalcheckonyourhealingprocess.Ifyourstitchesarenotreadytocomeoutandyouareanoutoftownpatient,wewillhelpyouplananappointmentwithaphysicianinyourhometowntoremovethem.Afterthethirdpost-opappointmentouroutoftownpatientsarereadytoflybackhomeandgetbacktotheirnormallives.Sinceeverypatienthealsdifferently,wealwaysrecommendouroutoftownpatientspurchaseanopen-endedplanetickettobesafe.Ournumberonepriorityismakingsureyourbodyhealsproperlyafteryourparotidectomyandwehavefoundthatourhands-onpost-opappointmentswithDr.LarianandDr.Azizzadehensurethissuccess.While,itispossibletoflyhomesoonerafterthesurgery,westronglyencourageourpatientstoattendall3post-opappointmentsattheCENTERforAdvancedParotidSurgery.AtHomeCareIncision

o Beforeyoutouchyourfaceorcleanyourincisions,washyourhandswithsoapandwarmwater.

o Cleantheincisionsinfrontoftheeargentlywithaq-tipandhydrogenperoxideonceaday.

o Antibioticointment(Neosporin,Polysporin,Bacitarcin)purchasedoverthecounter,shouldbeputontheincisiontwiceadayforthefirst10days,followedbyvitaminEointmentorbioCorneumforthenext2months.

o Crushediceinrubbergloves,coldcompressesorfrozenpeasshouldbeusedfor72hoursonanhourlybasiswhenawake.After72hours,usewarmcompressesinareasofbruising.

o Youmightnoticebruising,swellingandhardnessaroundyourincision.Thishardnesswillpeakatabout3weeksandwilldisappearoverthenext2to3months.Firmmassagingofthescarstarting2weeksaftersurgerywillhelp.

Drain

o Thedrainshouldbeemptiedatleasttwiceadayandtheamountrecorded.Thisrecordshouldbebroughttoyourfirstappointment.

Dressing

o Thesurgicaldressingwrapshouldberemovedatyourfirstpost-opappointment.o AnAceWrapshouldthenbewrappedaroundtheheadtightlytohelpreduce

swelling,especiallyatnights,for2weeks.Theswellingintheareaofsurgerywillincreasethefirstseveraldaysandmayhaveadonutshapetoit.

o Swellingwilllast2-3weeks.AdditionalAtHomeCareInstructions

o KEEPHEADELEVATEDWHILERESTING,RELAXING,ORSLEEPINGFORATLEAST1-2WEEKSFOLLOWINGSURGERY.SLEEPONYOURBACKONLY.Sleepisvery

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importantsolaydownatanelevatedanglethatallowsyoutosleep.o Youmayshowerwithlukewarmwaterthedayafteryourdrainhasbeenremoved.

Whendryingoff,delicatelypatdry.Donotsoakinabathtuborspendaprolongedtimeintheshower.

o Noheavyexerciseoryogafor3weeksfollowingsurgery.o Keepallincisionsprotectedfromsunexposurefor3monthsfollowingsurgery.

POST-OPERATIVEDIETSUGGESTIONS

o DRINKPLENTYOFLIQUIDS:Pleasedrinkasmuchwateraspossible,inadditiontootherliquids,suchasGatorade.Avoidsodasandcaffeinateddrinkforthefirstcoupledays.Citrus-basedjuicesmayirritateyourstomach.

o Good,nutritiousfoodonthefirst2-3daysareveryimportantinthehealingprocessandwillhelpyoufeelstrongersooner.Startwithsoftfoods.Herearesomesoftfoodsuggestions:mashedpotatoes,warmsoups,cooked/boiledvegetables,cannedfruit,oatmeal,creamofwheat,babyfood,yogurt,bananas,applesauce,JELLO,pudding,fruitsmoothies.

o NOSMOKINGo NOALCOHOLo NOdietfoods.NOdietdrinks.Yourbodyneedsthecaloriesforproperhealing.o NOaspirinoraspirinbasedproducts(seeattachedlist).o NOsaltyorspicyfoods.o NOgreasyfood.o NOhottemperaturefoods(warmispreferred)asitmaycausebleeding.o NOheavyorbigmeals.Startsmallandlight,thenslowlyincreaseastolerated.

Ifyouhavequestionsrelatingtoyoursurgeryoutsideofourregularofficehours,pleasecallusdirectlyat310.461.0300.

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SUGGESTIONSTOMINIMIZESWELLING,BRUISING&SCARRING

ArnikaForteisourpreferredtreatmentforswellingandbruising.ItistheonlycombinedArnicaMontanaandBromelaincapsuleonthemarketandcanonlybepurchasedfromaphysician.Treatmentstartsthemorningofsurgery/treatmentandcontinuesfor6daysafter:take2tabletsatatimeeachday,foratotalof7daysuntilallcapsulesarecompleted.

UsingbioCorneum(BC+),aself-adheringsiliconegelwithSPF30,willprovidethebestenvironmentforascartohealandwillhelpspeedupthehealingprocess.Threedaysaftersutureremoval,startapplyingBC+twiceaday,verysparingly,toyourscarfor12weeks,oruntilyoustopseeingnoticeableresults.Onedropisenoughtocovera3-inchscar.Ifyouhaveatendencytoformhypertrophicorkeloidscars,youmaywanttouseitfor6monthstoayear.BC+shoulddryrightawayandwithinafewminutesformaslicksurfaceoveryourscar.BC+willgraduallywearoffthroughouttheday,whichiswhyyouhavetoreapplyitagainatnighttomakesureyouaregettingasolid24-hourperdayexposuretothesilicone.

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ASPIRINCONTAININGCOMPOUNDS&MEDICATIONS

***IMPORTANTINSTRUCTIONS***Aspirinandaspirin-relateddrugs(includingarthritisandcoldmedications)causeprolongedandexcessivebleedinginnormalindividualsduringsurgery.Therefore,youmustnottaketheseproductsfor2weeksbeforeand2weeksafteryoursurgery.ThefollowingisapartiallistofmedicationscontainingAspirinthataretobeavoided:

*IBUPROFENISALSOKNOWNTOCAUSEPROLONGEDBLEEDING&SHOULDBEAVOIDED*Ifyoumusttakesomethingforreliefofheadache,menstrualcramps,backache,etc.,pleasetakeTYLENOL(asdirected)forthe2weeksbeforeand2weeksafteryoursurgery.Tylenolshouldnotbecombinedwithprescriptionpainmedications.PLEASECHECKALLMEDICATIONSYOUARETAKINGFORASPIRINCONTENT.IfyouaretakingamedicationnotlistedaboveyoumaycalltheofficetochecktheAspirin/Ibuprofencontentoryoucancontactyourpharmacist.Allherbalmedicines,vitaminsanddietary/nutritionalsupplementsneedtobestopped2weekspriortosurgerybyweaningover3days.

A.P.C.AdvilAleveAlka-SeltzerAnacinAnaproxArthritisPainFormulaAscodeen-30AscriptinAspirinSuppositories(allbrands)AspirinBayerAspirinBuff-a-CompBuffadyneBufferinButalbitalCarnaArthritisPainRelieverCarna-InlayTabsCheracolCapsulesCongespirinCopeCoricidinCoricidinDarvonCompoundDristanDoan’sPillsDuragesicEcotrinEmpirinEmprazilEquagesic

ExcedrinFiorinolFour-WayColdTabletsIndocinMeasurinMidolMonacetwithCodeineMotrinNaprosynNorgesicNuprinOs-Cal-GonePamprinPamprin(Buffered)PanalgesicPepto-BismolPercodanPersistinPropoxypheneRobaxisalSine-OffStendinStero-DarvonwithA.S.A.SupacSynalgosSynalgos-DCTolectinTraminicinVanquishVoltaren